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The Future of US Healthcare with Dr Fabrizio Mancini and Dr Avi

Dr Avi Ratnanesan: Hello, Dr. Fab. Dr. Fabrizio Mancini. It’s really great to connect again, Dr. Fab. It’s been a while since we last spoke. You’re such an accomplished person, and a person that has a fantastic smile that I just so wanted to connect with you. You’re a bestselling author. You’re an incredible integrated practitioner, chiropractic physician. You host your own radio show. You’re a health leader that I really, really admire. How are you doing over there?

Dr Fabrizio Mancini: Fantastic. It’s so great to connect with you, and most importantly, you know what? It’s having this conversation because it’s important for us to really try to understand really what’s going on in the world so we can be more effective; not only in our personal lives but in our professional lives.

Dr Avi Ratnanesan: Yeah, absolutely. Dr. Fab, you are the President of Parker University. You are a great educator there. You’re currently based in Dallas, Texas as well. Is that right?

Dr Fabrizio Mancini: Yes, can you tell my Texas accent?

Dr Avi Ratnanesan:
Yes, it sounds very …

Dr Fabrizio Mancini:
It’s wide.

Dr Avi Ratnanesan:
Very sudden. I think the people in Australia are going to be really confused right now in real admiration of your accent. Dr. Fab, can you tell us a bit about as the practitioner that’s so highly achieved, what is your day-to-day life like as a practitioner? What do you get involved in?

Dr Fabrizio Mancini:
It’s interesting because my first nine years after graduation from school as a doctor of chiropractic I spent as a practitioner, and my regular routine was primarily getting up early in the morning, working out, going to the office, taking care of patients, coming home, having dinner with my family, and being a dad, et cetera.

Then, my last 13-and-a-half to 14 years, I’ve been an educator as President of Parker University in Dallas, Texas. I just retired as President, so I am not President Emeritus, and my routine for those 13-and-a-half years was long, long days starting from early morning, sometimes until late at night because you have events, you have speeches, you have travel.

Here I am, with one of the leading chiropractic brandings in the world, one of the leading chiropractic schools. We have the largest chiropractic seminars. We also have one of the largest chiropractic product companies, and my role was to manage all of that, 300 employees over 1000 students, over 6000 alumni. Then, of course, through parker seminars, we have trained out of 100,000 chiropractic in the world, probably about 70,000 of them.

It’s a lot of responsibility but one in which I was at the post of what was going on in healthcare in order to make sure that we are moving in a direction that is solving the problems of today rather than in a paradigm that is stuck in the past and is not really being effective today.

Then, the last year-and-a-half, here is my third chapter in my life. I write this fourth book of mine that becomes an international bestseller. I am getting invitations to speak all over the world, to do television, to do radio, and to get out there in front a lot of people. It’s a very different routine because it’s very scattered.

Today, it was just only four meetings, very important meetings today but the rest of the time was nothing else. Tomorrow, I have six meetings. Then, on Wednesday, I start traveling for the next four days, from city to city. It can be very tasking but that’s why it’s so important.

My secret to success or my secret to being a good communicator has always been the same. We must live our message. If I am trying to promote and wellbeing around the world, then my message has to be or my life has to be one in which I am living that message. It’s a pretty exciting life. I feel so blessed every day that I get to do it again, and again, and again.

Dr Avi Ratnanesan:
That’s wonderful, Dr. Fab. You talked a lot about the passion. You speak of so much passion, and the enormous contribution that you’ve given to healthcare in the US and around the world as well, of course. What is your message? What is your personal vision and mission because one of the things we find in terms of practitioners in healthcare and also leaders of healthcare is that we’re largely driven by personal vision and mission, some things that really comes from inside. What’s that vision and mission for you?

Dr Fabrizio Mancini:
In 1988, I am sitting in a seminar in Miami, Florida, and the speaker that I was hearing was talking about the importance of writing a mission statement for your life. I went and spent eight hours with a series of questions that he gave was to keep asking ourselves and to the essence of that mission really stood out.

For me, it ended up being one sentence. That sentence has never changed since 1988, and that is to learn to unconditionally love myself so I can unconditionally love others. I have found that with all my studies with theology, and science, and psychology, and all of these other things that I have done in my life, I have found that the common denominator for all success, for all healing, is actually love because when we unconditionally love ourselves, we give ourselves permission to succeed, to be healthy, to be happy, to be peaceful. That has been the foundation for in which I have built everything in my life.

Dr Avi Ratnanesan:
That is a very deep vision and mission, and we’ve gone really personal really early, but I think that’s good because it just tells us a bit where you’re coming from as an individual but also as a healthcare practitioner. Some would say. Dr. Fab, particularly a lot of people who have been in for a long time, and we’ve even seen stats that up to 50% in some areas of doctors and healthcare providers disillusioned or even depressed with their jobs, and don’t really see or get that satisfaction that they get.

I suppose, Dr. Fab, in terms of the US healthcare system then and coming at it from your angle who’s obviously seen a lot in that area, what do you see as being the major challenges for the healthcare system in the States?

Dr Fabrizio Mancini:
Our system in the States is broken just like many other systems around the world. To me, what I have noticed is that the healthcare system in the United States has been a system that has always been driven by profit, and you say business. It’s a business system. When you get to the higher levels of that system, whether it’s pharmaceutical companies, hospitals, manage care companies, you will not find doctors managing those companies. You will find some of the top business people around the world that are managing those companies. Everything is driven by the profit line.

Once you understand that component of it, now you say to yourself, “Well, if I am managing that system, wouldn’t it be great if I could get everybody healthy,” but the challenge is that the healthcare system doesn’t pay if people are healthy. It only pays when people are sick. All of a sudden now, we have a dichotomy which means that we, as healthcare providers, are making an oath that we’re going to help people get well but we are given very set limitations of how we can do that.

For instance, the reason I changed from traditional medicine into chiropractic was because I was noticing that pharmaceuticals and surgery were not addressing the chronic illnesses of today, and I was seeing those numbers rising every single year, and I was always very futuristic, and I still am. I was thinking, “Where is it going to be 25 years from now? Where is it going to be 50 years from now? Am I going to start a profession or a specialty right now that is going to be a demand in the future?”

Statistics in the United States is that over 75% of the cost and the diseases that we’re serving through our healthcare system is chronic illnesses, and those are your cardiovascular diseases. Those are your cancers. Those are your arthritis, your diabetes, and now, of course, your obesity which is creating tremendous cost and stress into our healthcare system.

When you’re going through the process and s a physician, you’re going to school with this intention, and trust me, I read the applications of every entering student and the same thing is always, one-by-one is I want to enter healthcare because I want to help people. I want to help people with their challenges, their health challenges, and I want to be of service to humanity in that way. I never have people writing in their application, I want to make a million dollars my first year at the practice. I never have that. It’s always a service intention.

Then, guess what happens? To be able to get to that point, you have to actually pay a lot of money. In the United States, unfortunately, education is becoming very costly. In Parker, we had about 95% of our students have to borrow their money to go to school, and they are graduating with an average of $250,000 to $300,000 in debt by the time they finish.

Of course, they have all that debt going on. They go into the real world. Maybe there is not a lot of jobs out there available for them to be hired so they start thinking about opening their own practice, but then, they realize that maybe they didn’t get enough business acumen to run that practice, and then, they struggle. Then, they get frustrated, and maybe this is where it happens. Maybe they start questioning, did I make the right decision?

It’s so sad because it has nothing to do with the health of humanity. It has all to do with the business of your practice, the business of healthcare, and if you don’t understand that business, unfortunately, you’re going to get frustrated too and you may be even more frustrated like many doctors are right now. We can talk about specifics in the healthcare system in the United States.

Dr Avi Ratnanesan:
That’s such an amazing insight. It’s something that I am very passionate about which is, as you know, the economics side of healthcare and the business side of healthcare, and recognizing that there is a need for us to bring the two together in a way that’s contributing to better patient outcomes overall.

What do you see as the … I suppose, can profit and healthcare go together? Is that even possible in the first place? If that is possible, how do we do that and how do they do that in the US healthcare system?

Dr Fabrizio Mancini: That is a great question. We have two trains of thoughts. The first train of thought says, I have X amount of patients, what services can I provide to those patients, and what is the most that I can get out of each one of those patients? The second train of thought is, I am going to set up a level of healthcare in which I believe is going to give the best results out there regardless of the economics, and then I am counting that those best results are going to create such a word of mouth, such a referral source, that is going to allow me to continue to grow my practice and build my practice.

In one, one of the challenges is that the expenses of running a very high technology, a very high volume, a very high tech or expense practice means that you have to charge a lot of money in order for you to make some money. Then, we see on the other hand, services that are very holistic in nature that are having great results that don’t cost a lot of money but the referral or the word of mouth is growing, and growing, and people are becoming more up to it.

Then, out of those two, now we have a third model which is what I’ve been watching very carefully the last five years and it’s called the Integrative Model of Healthcare. I was one of the first decisions that was asked by President Clinton to give testimony on the White House Commission for Complementary and Alternative Medicine. In those days, President Clinton wanted to come in and bring the effort of complementary and alternative medicine, so they called it in those days into the healthcare system.

The problem was that the lobbyists were keeping that from happening because it didn’t have an upside. It didn’t have money attached to it. Hospital providers and CEOs were telling me, “Look, Fab. I would love to have chiropractice and acupunctures in my hospital but I can’t get paid for those things, so I can’t do that, so we’re going to continue to go into the mode of traditional healthcare. We’re going to do high level of diagnosis which in this country,” as you know, we spend almost 90% of our dollars in diagnosing a problem and less than 10% doing something about it. That is the reason why it was such chaos.

The hospital system and the hospital models have changed now. In the United States under the new healthcare system, they’re going to be capitated. That means that they’re going to give X amount of lives.

They’re going to get X amount of money. Now, the same CEOs are calling me and saying, “We want to hire chiropractice. We want to hire acupunctures. We want to bring in meditators. We want to bring in classes like yoga and other things that have been proven to actually help these chronic illnesses,” because the more money they can save in the treatment, the more money they get to keep in their pockets.

The model has changed but the one model that has really disturbed me lately is that ten years ago, 70% of the medical doctors in the United States are on their own practices. Right now, that number is 30%. 30% of the medical doctors now on their own practices. Everybody else is now working for a third party which is a monitored company and hospital, and governmental agency, or a corporation.

The challenge with that is that we have lost the sense of entrepreneurship of health and I would love to bring that sense back because when you’re an entrepreneur, you better deliver on your services and it’s outcome-based. Meaning that if you get results in your patients, your patients will make sure that you got enough business coming your way, and we have lost that in healthcare. It has become about let’s do all these services regardless whether we can prove that the patient is getting well or not. Let’s do this surgery regardless if we can prove that can help the patient or put the patient on disability after four years of scar tissue build up.

Those are the things that are not tolerable anymore and those are the things that we’re going to see a lot more emphasis.

The new healthcare system has four priorities that I’ve identified in the United States. The first one is they are moving very strongly towards preventative care. That means that they are going to actually pay for things that have been shown to be preventative in nature because they have figured out that it’s less expensive to treat something early on that once is a full-blown disease or condition. That is the first thing that I want you to keep an eye on.

The second one is that it has to be evidence-based. Meaning that there’s many procedures out there that haven’t really been tested or they’ve been tested very minimally but they are charging a lot of money for. Now, they want to make sure that it’s not only evidence-based but that it gets the third thing, that it gets results. If you have the evidence but you don’t have the results, you got to have a hard time getting paid in the future but if you have the preventative nature, the evidence, and the results, you’re going to have a tremendous opportunity in the new healthcare system.

The fourth thing, and this is very important, because this is coming from the Sergeant General’s mouth. She said that it has to be collaborative in nature rather than competitive in nature. Meaning that the new healthcare system is going to ensure that all providers are working for the benefit of that patient rather than for the benefit of themselves. We’re going to have to remove the ego out of the equation, and providers need to come together and work towards one common end.

Tomorrow, I think I mentioned to you earlier, one of the biggest cancer hospitals in the United States, it’s called Cancer Treatment Centers of America. They have five hospitals, huge, huge hospitals. What they’re doing is that they have pioneer for the last, I think it’s been seven or ten years, the integrative approach towards cancer where now, you have an oncologist and psychologist with a spiritual training background, a naturopath, an acupuncturist, and a chiropractor all working for the benefit of that one patient.

I think you’re going to see more and more of that in integrative practices. Meaning that the MD, the DC, the acupuncturist, the massage therapist, they are all going to work together. Now, we’re seeing it in groups. Let’s say that you have a pediatric group of medical doctors, they are encouraging a chiropractor with a specialty in pediatrics to join that group, and give the holistic conservative approach to that care of that pediatric patient. That’s what I envision and how everything is unfolding as I see it right now.

Dr Avi Ratnanesan: What you’re seeing. Fab, is really important. That’s extremely insightful into what’s going on. I’ve got a number of follow-on questions from there because it has really opened up a whole number of areas over there.

Dr Fabrizio Mancini: The response maybe if I [crosstalk 00:18:04].

Dr Avi Ratnanesan: There are so many ways that we can go with this, but I want to touch on some of the things that really are on everybody’s minds in terms of complementary and alternative medicine. I think, you guys over in the States are a little bit more advance in terms of developing the evidence around complementary and alternative medicine. Over here in Australia, we’re still lagging behind in terms of compiling that information and communicating that information to broader community.

Can you tell me a bit more about the evidence-based behind complementary and alternative medicines? Is it growing in the United States? It is easier to access that information in the States? If so, what are the best sources of that information?

Dr Fabrizio Mancini: In the United States, they challenge us and the economics is driving the decisions now. In the past, it used to be that the medical doctors that were very traditional in nature that were actually serving in many of these communities were not very open minded to many of the other healthcare professions that are more holistic and natural in nature.

I’ve been fortunate that I lived in three different continents, and I remember when I lived in Europe, homeopathy was huge. Everybody was using homeopathy before in medicine. In the United States, homeopathy is in its infancy. It’s just getting started. If you go to China, Oriental Medicine, tradition medicine, acupuncture is very, very much revere. In the United States, acupuncture has been reduced to mostly pain management which doesn’t give it the importance that it has in other countries.

The thing is that now that the economics are not working with the traditional means, all these committees have been asked to change and look for solutions into the world. The National Institute of Health which is our number one source of funding for all research in the United States, a good friend of mine serves on that board. She says to me this, and you and I were talking a little bit about it before. She says, “You know, Fab, for so many years, we were like spending all these money on research on the generic factors, on the genes, and now, we realize that epigenetics is where everything is at, and we’re doubling our funding towards epigenetics.”

To me the benefit of epigenetics is that it’s bringing relevance – and that’s the keyword, relevance – to this holistic traditional professions because we have always been about trying to get to the root of the problem rather than managing a symptom. One of the reasons I became a chiropractic was because I didn’t want to just mass symptoms. I wanted to get to the root of the problem, and I knew that the root of the problem was not just physical. It was emotional and spiritual in nature.

I also knew that the root of the problem was something that the patient was not paying any attention to because society has not conditioned us to think like that. We were always just trying to numb the pain. Now, to me, the pain is only the alarm system of the body. It guides us. It tells us just like a good friend coming to visit and say, “Fab, there is a problem here. We need to pay attention in what you’re doing here. Maybe this work is really hurting your back or maybe this food that you’re eating is irritating your digestive system, or maybe
this drinking that you’re doing is lowering your immune responses, maybe not so much drinking is healthy.”
Whatever the case may be, if you think of your pain as your best friend that is coming to visit, just warn you and just to guide you, just to tell you that there is something deeper going on, you will make better decisions in your healthcare.

Dr Avi Ratnanesan: That is such an important message, Fab. It’s one of those things that’s a real challenge for people to really look at illness in general or really look at their own pain because obviously, when you’re sick and I had an illness a few weeks ago that really knocked me out for a good two weeks, and I kept looking at it as “Oh gosh, you know, this illness is keeping me out. I can’t work. I can’t go out. I can’t see my friends,” but it really was an opportunity and a bit of a wakeup call to say to myself, “Look, I better look after myself a bit more. I better look after where I hang out, what I eat, and just have that greater consciousness.”

It’s one of those things where I heard a talk by Michelle Bridges who is a celebrity here in Australia. She is one of the chief personal trainers on the Biggest Loser Show of the Australian version.

Dr Fabrizio Mancini: Wonderful. Wonderful.

Dr Avi Ratnanesan: She was saying that if you don’t listen to [inaudible 00:22:43] keep smacking you and where the illness is, with catastrophes, with calamities until you get the message that you need to look after yourself better, and look after the food that you eat, the thoughts that you project.

Dr Fabrizio Mancini: That’s that process.

Dr Avi Ratnanesan: The lifestyle choices that you make. Absolutely right. Absolutely. You talked a lot about the preventative care, the integrated care model, and I am going to say a few things a little controversial here because I really feel that I agree with you in the sense that the multidisciplinary care approach integrating modern medicine with chiropractic and other holistic therapies is the way to go.

Having said that, a couple of things. Number one, you mentioned that the Natural Institute of Health and the science behind this integrative approach, the question is with having more providers and more health practitioners looking after someone, doesn’t that drive the cost up first? Then, secondly, somebody would say, where is the science having this approach? Where do we go to for that source of information? Do we go to the Natural Institute of Health or are there other places that we can go?

Dr Fabrizio Mancini: That is a very good question. I don’t disagree with you. To me, I’ve always said that for us to be able to be effective in society, we must go where the patients are. Most of these providers that are trying to open their practices, and market, and try to bring the people to them is a lot tougher than if you already go where the people are.

I’ll give you an example. In the country of Mexico, the governor in the state of Mexico which is 25 million people which is now the new president of the country have invited me to come laying health in a project. What he wanted was he put the Secretary of Education and the Secretary of Health in a room so I can meet with them. They wanted to ask me how can I help them bring chiropractic, and acupuncture, and natural healing into their education system.

The reason was because in Mexico, for over 20 years, they have not allowed any new medical schools open up. All the medical doctors that were graduate and most of them were unemployed. There was just no place to put them. He wanted to create new degree programs that were very advance and had evidence behind it, but they wanted to actually serve the people that were becoming educated but now, they can have a job after they finish.

The Secretary of Health had a different priority. 95% of the cost in Mexico is paid by the government. They are their own insurance company, 95% of the caps. Then, he wanted two things. Can you help me reduce my cost and can you help me prove the patient satisfaction of a healthcare system from the 20s into higher numbers? I said, “Okay. Why don’t we do this? We’ll bring in the profession.” We created the degree programs. We brought them into the university. They were so excited about it that the government subsidized those degree programs.

I’ll give you an example. To become a doctor of chiropractic in the United States, the tuition alone is about $120,000 on average. In Mexico, it’s US$800 for five years to become a chiropractor. The government subsidized this. If you look at the universities, they are prettier and better than anything that we have in the United States because they paid for it all.

The second thing is that we took the Secretary of Health and said, “Would you give us a hospital or a few hospitals in which we can integrate this holistic providers with your traditional providers?” What ended up happening there was in one hospital alone, they started replacing the medical doctors with the holistic providers. They lowered in one year by 50% of their cost, and the patient satisfaction went from below 30s in that particular hospital into the low 80s in one year.

When I talk about integration, I am not talking more cost. I am talking about reducing cost by replacing what’s not working, by changing what is not working, by not doing this unnecessary procedures. If we’re in a room, and you have one traditional doctor saying, “What we need is more MRIs. What we need is more of this,” and a holistic conservative guy says, “No. what we need is more of this and change the behavior on that patient, and more education, and more holistic treatments,” then you’re going to have an opportunity to make better choices and not just do all these procedures for the sake of doing the procedures just because insurance companies are paying for it.

The reality is they’re not going to pay for it any longer. That world is gone. They are reducing the fees. Just to give you an example, there was a treatment. It’s a nerve conduction exam that was paying without any questions $7000 any time you did it on a patient. Guess what the average reimbursement is now? 450. That means that the insurance companies are not going to pay you what they used to pay you on those. The question now, is it relevant? Is it needed? Is it really going to help this patient or help me try to figure out what is wrong with this patient?

What I find as a challenge in your healthcare systems around the world is that there hasn’t been enough integration from the perspective of a different paradigm looking at that patient from a different perspective and saying, “Hey, could it be this?” or “Why don’t we try this?” or “Instead of doing more surgeries on this, why don’t we do something more conservative in nature?” and that is really where I am coming from in that perspective.

Dr Avi Ratnanesan: That is really interesting, and once again opens up that Pandora’s Box. We’re opening up the big box and then the smaller boxes as we go.

Dr Fabrizio Mancini: It is a journey. It is a process.

Dr Avi Ratnanesan: It is a process and it’s really important what you’re saying because it really forces people to think and look at real issues which are as we know are improving patient outcomes and patient satisfaction, and we’re getting better and better at measuring that, although I still feel that there is a way to go in terms of how we measure that. On top of that, the cost equation which is much easier to measure but does take some time to really see the results around that.

I guess equation would be then for all those who are doing modern medicine and practicing modern medicine. I train in modern medicine. I took those big loans. I was fortunate to get some scholarships to help me along the way and get me to medical school which I did in England, and it did take me a number of years to pay those loans back. Obviously, all my doctor colleagues that are out there paying back those loans, and also trying to make a living, and have a life at the same time, and doing the long hours like you’re doing.

They obviously might feel threatened in a sense and saying, “Well, now, we’re going to take away the patients from what we’re doing.” What is your response to that? What do you feel is the right way to go in terms of … Where do we place modern medicine then with holistic therapies? How do we tackle that issue?

Dr Fabrizio Mancini: A very good point, and I am not sure where we are in Australia with the statistics but in the United States, two years ago, the statistics was less than 5% of the medical doctors stayed as general practitioners. They actually go into specialties. The problem is that the United States, we have the biggest efficiency in primary care physicians in the history of the United States. There is not enough doctors to take care of all the people.

Now, we have plenty of specialties, but we don’t have enough general practitioners. Because of that deficiency, guess what is happening? Now, the chiropractor is getting position to be, where at most stage were primary care physicians. Their physical therapists have added more degrees to their curriculum to be Doctorate of Physical Therapies because they want to play in the arena. The nurses are now becoming doctors of nurses because they want to play in that arena.

What is happening right now is that because of that deficiency, we don’t have enough doctors to take care of the primary, or the elementary, or the diseases that are more generic in nature that before it goes into the specialty. What’s happening now is that with the manage care system, the way that it was, you can only see so many patients in a day in order to actually end up with a profit at the end of the year. You will have to scale your patients because they are actually paying you, and some of these group models, decapitating your income.

What I do think is that if you’re a medical doctor right now, my question to you is, if you’re going to be a specialist and you are right now a specialist, then try to find a way that your specialty can actually somehow support the chronic illnesses of the world because that is where 80% of our money is going to go anyways. Why not take a respiratory specialist into some of the chronic illnesses that now they can do not only effective treatments to manage that care once the disease has already progressed, but how about doing some preventative procedures also in which they can now be able to serve in that capacity?

Now, this year, I had the blessing to speak at a lot of the traditional medicine conventions, anti-aging conventions, functional medicine conventions, and integrative medicine conventions. I can tell you there is a movement in which many of these medical doctors are beginning to recognize that they want more training that they did not receive traditionally to expand their services to their patients, and to importantly address the results issue to ensure that they are going to be able to help that patient get better results.

I think that automatically is happening but I don’t think it should be viewed as a threat. I think that as long as … I just gave a lecture two weeks ago in Washington DC full of legislators, senators, congress people, leaderships in the healthcare and my message was that the best way we can navigate through this Obama Healthcare System is to always put our patients first. That if we make decisions based on what’s going to get results, what’s going to help that patient the best, and not try to protect our leader pie in the slice pie that has provided for us as a profession or as a healthcare provider, but instead to take a look at that pie, and say, “Where else can I play? What are the slices can I play in in order to be able to serve that patient a little bit better?”

Dr Avi Ratnanesan: That is such an important message, and I think that is very, very relevant to the stakeholders in Australia and New Zealand where we also see a lot of silos occurring amongst specialty care, primary care, pharmacy, alternative health, allied health, et cetera, and we have all the different stakeholders trying to fight for the pie, and really what we need is that more, as you mentioned earlier, that collaborative approach to its patient, putting the patient first and [crosstalk 00:33:47].

Dr Fabrizio Mancini: Also, to listen to what the patients are doing. In 1997, in 1999, Harvard Medical School did a study that showed that there were more visits to known traditional providers in the United States, and that most of those visits were paid out of pocket. Of course, the Journal of Medicine writes it up and tells all their medical doctors, you got to ask your patients, “Who else are they going to other than yourselves, and why are they going to other people? What is it that you’re not doing?”

That began this process of trying to understand. Now, we have most every single medical school in the United States is teaching the science and the benefits of non-traditional medicine. Why? Because we have to work more in collaboration.

You bring a very good point from when it talks about the business of healthcare. In the United States, the business of healthcare now is one that is trying to meet the needs of the patients, and that patients are only going to other providers because you’re not meeting their needs. It’s not anything personal. The problem is that if you take a position to say, “You should never see that provider because there is no science behind it.

That is not going to help you,” but then that provider is the only one giving them relief. That provider is the only one repairing their process or restoring the health in their bodies. Then, all of a sudden now, you lost your credibility and your trust with that one patient. That patient now is going to leave your office, and go to another provider that is more open minded.

My message to you if you’re listening is regardless of what provider you are, understand that not one provider can solve the issues of today. That is the first and foremost. None of us can do it alone. That the answer for the future of healthcare is going to be in collaboration. It’s to leveraging our strengths. If I know that you are trained as a traditional medical doctor, I am going to leverage your strengths when it comes to certain cases and progressions of disease processes because I am going to be helpless. I am not going to be able to help that patient at that state.

Now, when it comes to preventative and having that patient not come back to your office a year from now, like my cardiologist friend. I have one of the top leading cardiologist. I work out with him in the mornings, 5:00 in the morning. This guy is just so fit. One day, in the locker room, I just said, “Michael, what is your motivation to get here every morning?”

He says, “Fab, if my patients did what I do every day, I will not have as many patients as I do as a cardiologist.” He said, most of things can be prevented. He says, “I get reminded every day what I need to be doing so that I don’t end up with my patients in my surgery room and having to do one quadruple bypass after another, after another,” and all of these things that he does on a regular basis.

That is his motivation. That to me is depending on where you are in your life, maybe you can be a little bit open minded to say that this system is not here to limit you in any way. It is actually here as an opportunity for you to leverage what your training is to be able to help more people. That is how I deal it right now.

Dr Avi Ratnanesan: That is such a fantastic message, Fab. There is more and more as you say, people that have this open-mindedness that are looking at ways to obtain these results. We know here in Australia, it’s a four-billion-dollar industry just the alternative health side, not the allied health side but purely the alternative health side.

There is a big demand in Australia to go in that direction. Really what we need is that a better communication between the modern medical practitioners and the alternative health practitioners to get that integration happening really slick, and it starts with that mindset. It starts with that mindset of being open minded.

Looking at you guys back in the States, and we have so much to learn there, what do you now see as the opportunities that ObamaCare will bring? Maybe just touch on what us ObamaCare for us that don’t know. I’ve heard about it but really don’t know all the details. We don’t have to go into the whole 527 bullet point but what is the key essence of Obamacare, and what do you see as the opportunities moving forward?

Dr Fabrizio Mancini: I’ll do my best for it but I can tell you that even lobbyists and legislators that I ask, it’s a big confusion state of mind in which everybody is saying because what happened was when Obama was elected, I don’t know if you remember, there was a time when Hillary Clinton tried to pass a revision of a healthcare system. She wanted to introduce different ways of thinking about how we manage healthcare in this country.

When Obama was elected, another Democrat, then they said, “Well, this is our opportunity.” My challenge was that as I was watching all of that unfold, I started recognizing that not enough thought process had been given to some of the discussions and how this was going to play out because they have thousands of papers that are trying to show us how this is supposed to be implemented but none of it has ever been done.

That means there is no track record. There is going to be a lot of mistakes. Companies were being told that they needed to provide healthcare at a certain level to every employee. Employees were being told that they needed to sign up into healthcare system by certain dates. All of that got delayed. All of those things. It was false starts. We’re going to start this day. Boom. I’m sorry we’re not ready. The website is not ready. Three months later, let’s start again. It’s been unfortunately a mess. I think it’s a mess because it wasn’t really thought out carefully.

The second thing that I see is that the paradigm has not really shifted. To me, to really have a new healthcare system, you first must implement a very effective self-care system because the self-care is the component of the healthcare that is costing us an arm and a leg. If people do not start changing the way they view their health and putting it as a top priority, if people do not start changing the way they eat for the better, if people do not start moving their bodies, if people do not start doing some type of meditation on stress release and techniques like bounce feedback and other, they are going to get to the point that their bodies are going to breakdown.

The best analogy that I can give you is the chronic illness of today is not the body is not designed to handle them. It’s just like you have … Let’s say that you get on a treadmill and you’re going to do it for 15 minutes, and your body can actually get you high rate to the point that it is going to handle that treadmill for 15 minutes with no problem but imagine that that treadmill never stops, and you’re running, and running, and day two, and day three. There comes a point in which our fight or flight reflex, in which our organ, somebody’s going to breakdown because our bodies would not decide to handle stress for a long period of time.

Everything in the body is designed for a short level of a response from the body to the stress that it’s supposed to not stay there for very long. Now, the stresses are there all the time from either emotional stress, even spiritual stress, and definitely physical stress. People are not sleeping enough. That’s stressful in itself. All of those things.

What is the ObamaCare trying to do? It’s trying to attempt to lower cost. That is our biggest issue right now. We have to lower the cost because it’s getting to be the most expensive item in our budget in the United States.

Number two, the second thing is to find that for the first time, this generation of children is not expected to outlive their parents. When we read those statistics, we were alarmed because if we continue this diabetes issues and obesity issue, these children that are being born today are not going to outlive their parents because of those issues. It’s just almost unthinkable to think that your child would not outlive you.

Then, we have a lot of emotional issues but we did not change the paradigm, in my opinion. We needed to go more towards holistic, more towards … Even though they said they are going to pay close attention to prevention, I am just wondering if that prevention is going to be limited to more vaccines, and more injections, and more pills that are preventative in nature rather than behaviors that are really the cause of the problem right now.

Dr Avi Ratnanesan: I couldn’t …

Dr Fabrizio Mancini: Yeah, go on.

Dr Avi Ratnanesan: I couldn’t agree with you more. We really need to look at the underlying behavior patterns with anything whether it’s a success as an entrepreneur, or success as a human being, or success in health. It really comes down to your behavior and those underlying behaviors that lead to that physical disease. Let’s just talk about …

Dr Fabrizio Mancini: Let me tell you the challenge because I want to make sure you get a good picture. The challenge was to find that this new healthcare system was going to make it easier for everybody. It was going to make it easier for patients to have access because we have about 36 million patients in the United States that had no health insurance. That was a big driving factor in selling it. We’re going to get all those people insured.

Number two is that companies were going to actually lower their cost if they actually will go along with this new program. Manage care companies were actually going to be able to be better managed because they are going to be able to manage their cost better; hospitals included. Then, of course, the provider. The provider was going to have more patients and was going to be able to serve more people. For many of these doctors that were not seeing enough patients, this was also very exciting.

The unfortunate fact is the fact that right now, this actually is costing more to the corporations, to the employees that in order to get that insurance, it’s going to cost them more money than they has, so they’re still struggling to their manage care companies because now they are having to really cut cost to the point that maybe some of these costs that were necessary are not going to be paid for because they are trying to balance their budget.

In all the levels that we were promised that this was going to be an effective new healthcare system, we just haven’t seen it. I think we haven’t seen it because I think, let’s go back to the business model of where I see the opportunity. The opportunity in my opinion is entrepreneurship because if you, as a doctor, are able to create services or products that are going to address the root causes of the disease process in your patients, you’re going to have a chance that the insurance companies will pay you for it because it’s preventative in nature but most importantly, we know that the patients will actually pay for it themselves if they see that there is value to it.

I just don’t want you to think if you’re a doctor out there and you’ve gotten used to this referral source coming to you without any little effort, don’t think that just because you may not be getting as many referrals as you were at one time, that that’s the end of the game. It just means that you need to get creative. You need to be open minded. You also have to be looking what is it that the patient wants because that’s our customer. When you fulfill the needs of our customer, you’re always going to have more business that you bargain for.

Dr Avi Ratnanesan: It’s such an interesting thing you said around the health entrepreneurship as a real potential solution because we do know that entrepreneurs and entrepreneurship really thinks outside the box and really has been the drivers for change around the world across all industries. It’s that sense of solving the problem.

Dr Fabrizio Mancini: I am going to give you an example. I want to illustrate one example. One of my friends is one of the biggest OB-GYNs in the area. The guy is so busy but as he was looking at his business model, he started recognizing that insurance companies were paying less and less for the same procedures that he had done for 20 years.

Then, he started getting creative. Him and I had a conversation. I just like him to see, I said, “You, Peter,” – it’s his name – “You need to be an entrepreneur. You need to think about how can you get into this world of what’s really the patients are looking for.” Guess what he did. He started getting into the hormone business, and he started learning about this hormone replacements, and he started learning about natural ways to increase their hormones naturally, and he began to give lectures on that.

Then. He realize that he was getting more patients into his OB-GYN practice by lecturing and creating alliances with his hormone companies in which he was also making money from. It was just like he devised three diversified income streams over the services that he had traditionally done, and his income is more than double rather than decrease. He just said to me, “I don’t know why other physicians are not doing this.”

Regardless of what kind of doctor you are, just understand that there’s people out there looking for answers and maybe you are the one that is going to provide those answers, or maybe you’re the one that is going to create the next new product that’s going to revolutionize some kind of disease process, and now, you were creative enough to say, “How can I put my education in just trying to solve this problem myself?”

Dr Avi Ratnanesan: I love that. I love this conversation, Fab, because when I initially agreed to … I wanted to interview you and you agreed, I had no idea we’d go on talking about health entrepreneurship as one of the topics but it is so important and it is something that’s so crucial to solving the healthcare problems of today.

Certainly, I also have an example where I was talking to a gastroenterologist really only two days ago who has been able to create the same breath testing tools for allergy testing and we’ve got some breath testing for allergy testing. He was able to do it at half the price of the bigger hospitals and able to deliver that online to patients for half the price. He is saying, “Look, my patients can get it now for half the price. They just need to order it online. We cut the price of what other guys are doing, and it’s just as good as service.”

He is now looking at developing that as a real business so he doesn’t have to spend as much time with patients but still provide a service in a different way. That’s really the way to go. That takes some courage.

It takes some guts. It also takes some collaboration. Collaborating with others.

Dr Fabrizio Mancini: It’s a different max set, but I’ll give you another example. Corporations right now are really struggling how to lower their cost. What you’re going to see probably in the future is that more corporations because everybody started doing it in the United States, they are going to have their health centers inside of their corporations instead of sending those patients out, and they are going to start hiring these doctors. They are going start paying them very well but they are going to also pay them based also on performance. Meaning, can you keep our clients and our employees healthy rather than just charge all these things for services? That is how they are going to set up those payment structures.

We’re also seeing that the pharmacy world has changed completely. In the United States, pharmacist right now has changed the models from the perspective of that you’re going to a pharmacist to actually get a prescription filled. Now, the pharmacists that are the large pharmacists are actually creating and hiring doctors to work out of their offices and do office visits, do screenings, preventative screenings. They do immunization. They do flu shots.

They are also getting into the compound business, and the compound businesses where now you can get some ingredients and instead of putting it in a pill or putting it in an injection, you put it in a compound that you rub in your skin, and it has much a greater chance of absorption in getting into another tissue or it can damage and have a side effect.

There’s all kinds of models out there but imagine the pharmacists which I never thought were going to be the entrepreneurs have now become a huge entrepreneur force in the healthcare system, and they have also changed their degree program to a Doctorate of Pharmacy where they can now play in the primary care provider realm because if they can provide those services, people are going to send them patients.

I am just saying, look, keep an open mind. This is not the end of the world. I was sitting on a plane about a year ago next to a beautiful, wonderful lady in her 60s, and very proper, very elegant, and we started talking. Her husband is a neurosurgeon. She starts talking to me about how much her husband is going into depression and because everything is changing the healthcare world, and he is not getting paid as much, and he is working twice as hard, and he is thinking about quitting.

I just talked to her about what I am talking to you. She got so excited. As soon as we arrived at the airport, she got on the phone, called her husband and said, “You got to talk to Fab.” I just talked to the man, and I just gave him some suggestions. I just said, “Listen, please do not stop doing what you love to do,” because the man really loved doing what he loves to do. You just need to find a better business model to do it in so you don’t give up what you love.

Now, we’re seeing a lot of doctors exiting in healthcare. We’re seeing that the doctors are not recommending their children like they’re used to. Their percentage of referrals by doctors had dropped tremendously into our schools. The reason is not because of healthcare. It’s because the business model of healthcare is no longer working. That’s what needs to be addressed. That is why I love the work that you’re doing.

Dr Avi Ratnanesan: Great. Thank you so much, Fab. Just one last question before we go because you’ve given so much great information. For all those practitioners out there, you’ve given us some advice and you’ve said, “Look, keep an open mind. Think about other business models in terms of how you can continue to serve the people you want to help.” You’ve mentioned, keep an open mind about integrating and collaborating with other practitioners to deliver the best care and keeping patients first.

Now, people want to know, how did you achieve success? What were your secrets? Because you’ve been on radio shows, you’ve been on TV shows, you’re regularly featured in celebrity, speaking at really respectable forums, what did you do to become a success for a health leader?

Dr Fabrizio Mancini: My first ten years, my whole premise was to serve as many people as I could in a single day. I woke up every day with a sense of urgency that society is struggling, society is suffering, society is dying, and I could maybe contribute a little bit to those people’s lives for the better.

That got me going every morning and I knew that for me to make that happen, I needed to speak out and share what was in my heart.

The best way that I built my practice is in chiropractic, when you have one of the best techniques on building a practice and this that we do a health workshop in our office once a week, you can keep it between 20 minutes and 30 minutes, and you talk about a relevant topic that people are reading in the newspaper, and the magazines, and the news, and you talk about how that relates to what you do in your practice.

Instead of doing that, what I did is I called the city that I live in, a 175,000 people. They said to me, “We do these workshops in collaboration with the hospital.” I said, “Well, in 175,000 people, and you promoted every week, how many people are you attracting to these meetings?” She said, “About 25.” I said, “Well, that doesn’t seem like a lot of people.” She said, “Would you mind if I did the next one?”

I created a title that was very relevant at the time because my friend, Steven Covey, had just wrote Seven Habits for Highly Effective People. I created a title for this city called Seven Habits for Highly Healthy People. It was beautiful. They promoted it, and I talked a little bit about what I was going to talk about. The lady calls me two days before the meeting and says, “Dr. Mancini. We’re changing the venue.” I said, “What do you mean?” She said, “Well, we have so many people coming that our largest meeting room is 500 people, and we’re turning people away, so we’re going to be in the main library in that building and that is where we can fit 500 people to have this event.”

To me, communication is the key. That was my key for succeeding as a practitioner. Then, as an educator, I learned one simple thing and that is as an educator, I need to understand the why I was doing what I was doing.

I didn’t really understand that well as a practitioner but I understood it as an educator. That people are motivated in action when they understand your why rather than your what, or rather than your when, or rather than your how, or rather than your whatever.

The “why” is the most important. In other terms, in marketing, they teach you, if you were a plane, you don’t want to sell the parts of the plane. You don’t want to sell how beautiful the cockpit is, the bathrooms the big, the leg room, et cetera. You want to sell the destination. To me, when I paired up my why with the destination where people wanted to go, as an educator, I was able to inspire people to go into the healthcare field because I share with them what is possible if they would just allow themselves and apply themselves towards it.

Then, I shared my success in practice which gave me the credibility for them to say, “Well, if this guy can do it, I can do it too,” because I always said, I am not any different than anyone of you listening to me right now. In fact, I probably have more hang-ups and more handicaps that you would ever know, but what I do have is always something very simple that my parents taught me and that is to believe in ourselves that we could do anything we set our minds to if we really believe that that is something that we love and that is something that we wanted to do. That is something that drives me every day.

My success as a university president and the reason we grew so much and we have to put a limit to our growth, and became such a big branding, was because I was able to share the why plus the destination, and that was the formula there.

Then, I write this book, and then I became a media personality. Now, I am doing my own radio show, TV shows, books, public speaking all over the world. Then, what I’ve learned in that lesson is very simple. It’s that first thing is that the people are more ready for the message that I ever anticipated. Then, I became a good listener. To be a media personality, to be a good communicator, you need to be a good listener. If you listen to what the patients want and you deliver them what they want …

One of the greatest advice I was given recently by a very good friend of mine that is very successful, he said, “You know, Fab, your problem is that you’re trying to do too many things for people that you think is important. Why not just do what they’re wanting you to do in the first place? Why not deliver on what they are asking you right now for? When you do that, the rest will follow; but if you never do that, you will never achieve the level of success that you’re meant to. You have people coming to you right now saying, ‘Fab, we want this from you,'” but here I am thinking I got to come up with another program. I got to come with something else. I got to develop this. I got to develop that instead of delivering that.

As my third stage in life, my third chapter in life, I wake up every single day giving thanks that if I have another day, I am not going to waste it. I am going to full force with everyone and everything that I am doing in my life with no regrets. As long as I understand that the people are more ready for my message than I ever thought was possible, then it gives me the sense of urgency that is up to me to get it out there because very few people are. That’s what keeps me driving every single day.

I’ll tell you. Even though that I sound very busy, I do have an amazing balanced life, and as you see my Facebook pictures, I do have a lot of fun in my life.

Dr Avi Ratnanesan: Yes, you do.

Dr Fabrizio Mancini: I do workout every day. I do meditations every day. I do all the things that are important to me. I call it me, “me time,” because when I take care of me, then I can take care of everyone else in my life but if don’t take care of me, I will wear myself out and I won’t be any good to anyone else.

Dr Avi Ratnanesan: So powerful, Dr. Fab. Summarize, take care of you as a person. Learn to communicate, be a good listener, and also just keep an open mind and understand the why. Understand why you do what it is you do, and communicate why it is you do what you do, and people will keep coming back. Such powerful messages, Dr. Fab. It’s really been great. I don’t want to take any more of your “me time” because we’ve taken a lot of it already.

You’ve been really generous with your information. I like to just thank you very much from all of us here in Australia, from all of the people that’s followed us all around the world because I am sure they are going to take away a lot from your message and I am sure, a lot of them will go out and implement what you’re saying to us all. Thanks again, Dr. Fab. I look forward to connecting with you again very soon.

Dr Fabrizio Mancini: Thank you, my friend. It’s been an honor. Thank you.

Dr Avi Ratnanesan: Thank you. Bye-bye. Bye.

About the Author: Dr Avnesh Ratnanesan

Dr Avi is a medical doctor with broad healthcare sector experience including hospitals, biotech, pharmaceuticals and the wellness industry. He is a leading expert who coaches and consults to senior executives, entrepreneurs, practitioners, organisations and governments.